Post-operative serum uric acid and acute kidney injury

被引:35
作者
Ejaz, A. Ahsan [1 ]
Kambhampati, Ganesh [1 ]
Ejaz, Noel I. [2 ]
Dass, Bhagwan [1 ]
Lapsia, Vijay [3 ]
Arif, Amir A. [1 ]
Asmar, Abdo [4 ]
Shimada, Michiko [5 ]
Alsabbagh, Mourad M. [1 ]
Aiyer, Ravi [1 ]
Johnson, Richard J. [6 ]
机构
[1] Univ Florida, Div Nephrol Hypertens & Transplantat, Gainesville, FL 32610 USA
[2] Univ Chicago, The Coll, Chicago, IL 60637 USA
[3] Mt Sinai Sch Med, Div Nephrol, New York, NY USA
[4] Univ Cent Florida, Dept Clin Sci, Orlando, FL 32816 USA
[5] Hirosaki Univ, Grad Sch Med, Div Cardiol Resp Med & Nephrol, Hirosaki, Aomori, Japan
[6] Univ Colorado, Hlth Sci Ctr, Div Renal Dis & Hypertens, Denver, CO USA
关键词
Acute kidney injury; Post-operative; Uric acid; GELATINASE-ASSOCIATED LIPOCALIN; NECROSIS-FACTOR-ALPHA; CARDIAC-SURGERY; HIGH-RISK; PREDICT; HYPERURICEMIA; RASBURICASE; SEVERITY; LYMPHOMA; OUTCOMES;
D O I
10.5301/jn.5000173
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: We hypothesized that post-operative serum uric acid (SUA) may be associated with acute kidney injury (AKI). Methods: In this prospective, observational study, the relationships between SUA, urine neutrophil gelatinase-associated lipocalin (uNGAL) and interleukin-18 (uIL-18), serum monocyte chemoattractant protein-1 (sMCP-1) and tumor necrosis factor-alpha (sTNF-alpha), and incidence of AKI were determined. SUA were divided into tertiles and their association with AKI investigated. Results: A total of 100 cardiac surgery patients were included for analyses. The 1st, 2nd, and 3rd SUA tertiles were associated with 15.1%, 11.7%, and 54.5% incidence of AKI, respectively. The 3rd SUA tertile, compared to the referent 1st tertile, was associated with an eightfold (OR 8.38, CI95% 2.13-33.05, p=0.002) increased risk for AKI. Patients with AKI on post-operative day 1 (n=11) were then excluded for the purpose of determining the predictive value of SUA to diagnose AKI on postoperative day 2 and during hospital stay. In comparison to the referent 1st tertile, the 3rd tertile SUA was associated with an eightfold increased risk for AKI on post-operative day 2 (adjusted OR 7.94, CI95% 1.50-42.08, P=.015) and a five-fold increased risk for AKI during hospital stay (OR 4.83, CI95% 1.21-19.20, P=.025), respectively. SUA (Area Under Curve, AUC 0.77 (CI95% 0.66-0.88, P<.001), serum creatinine (0.73, CI95%, 0.62-0.84, P<.001) and sTNF-alpha (0.76, CI95% 0.65-0.87, P<.001) had the best diagnostic performance measured by the Receiver Operating Characteristics curves. Conclusions: We conclude that post-operative SUA is associated with an increased risk for AKI and compares well to conventional markers of AKI.
引用
收藏
页码:497 / 505
页数:9
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